USP 143 Exam 2 questions n answers
passed
Problems with quality - correct answer ✔✔*Over/underuse (lack of tx standards, clear evidence
base) (payment structure, CT scan = 1/250 chance of cancer)
*Bias in peer-reviewed journals (EG: hiring ghostwriters)
*Medication/medical errors, ADRs, Nosocomial infections, bias in financial conflicts of interest
*inequalities (disparities)
*negligence/gaps in training (malprac system, lack of accountable certification)
*uncoordinated care (pcp < specialists)
*systemic errors
*high costs! w bad outcomes
*waste! (complex system = multiple payers, high admin costs)/fruad
*Unbalanced ratio b/w PCP and specialsits (rural << urban areas)
*Financial conflicts of interest
,*Biomed model --> patients/docs are uneducated
*malprac system
*underfunded public programs
*Slow diffusion of new evidence into patient care
Medical/Structural Issues (w quality) (4- FMND) - correct answer ✔✔1) FINANCIAL CONFLICTS
OF INTEREST
--Study found that 40% of practicing providers owned the services to which they referred
patients
--Physicians who benefit from referral to these labs/diagnostics referred 4x more than
physicians who didn't profit
2) MEDICAL ERRORS
--IOM: 44-98k deaths/year due to medical errors (3rd leading cause of death)
--Journals aren't trustworthy --> 52 cancer studies --> couldn't reproduce 47 of them
3) NOSOCOMIAL INFECTIONS (HAIs)
--Affects 5-10% of hospitlized patients ($20 billion HC costs)
4) DRUG COSTS AND ADRS
--Cost continues to increase, no price caps
--Drugs only have to be better than placebo
, --Trials -- frequently tested in young people, too brief to show side effects, hide negative results;
also run by drug companies; OVERDOSED AM: IN 2000: 2/3 of clinical trials were done by for-
profit research companies funded via drug industries
Cultural/Implicit Bias Issues in HC System (3) (wrt quality) (DID) - correct answer ✔✔1)
DISPROPORTIONATE ACCESS OF CARE
-- People from poor/underserved areas/POC/Homeless = higher morbidity/mortality, less
access, lower quality of care, incorrect/overtx
--STUDY: 228 million wrong predictions/med errors harm 1.3 mil ppl --> 100k die/year
2) IMPLICIT BIAS (combined w burnout = bad)
--Attitudes that lead doctors/researchers to unconsciously treat ppl differently based on race,
gender, etc
--Blacks are 2x less likely to receive pain meds for same injury than whites
3) DISCRIMINATION
--Black patients are systematically undertx
--EG: "race-based" estimates of GFR (indicates kidney function)-- under the assumption that Af-
Am have more muscle mass
Good quality consists of (CH. 10) - correct answer ✔✔-access, clear evidence-based guidelines,
correct evals (no over/underuse), organized system, well staffed specialists
IMPROVING QUaLITY (CH.10) (FMPPCCT (7)) - correct answer ✔✔-FINANCIAL SEP DECISIONS
FOR CLINICAL DECISION MAKING
-MEASURING PRAC PATTERNS (via outcomes + ind cases)
-PUBLIC REPORTING OF QUALITY
-P4P
-CLINICAL PRAC GUIDELINES (via Agency for HC Research and Quality)
passed
Problems with quality - correct answer ✔✔*Over/underuse (lack of tx standards, clear evidence
base) (payment structure, CT scan = 1/250 chance of cancer)
*Bias in peer-reviewed journals (EG: hiring ghostwriters)
*Medication/medical errors, ADRs, Nosocomial infections, bias in financial conflicts of interest
*inequalities (disparities)
*negligence/gaps in training (malprac system, lack of accountable certification)
*uncoordinated care (pcp < specialists)
*systemic errors
*high costs! w bad outcomes
*waste! (complex system = multiple payers, high admin costs)/fruad
*Unbalanced ratio b/w PCP and specialsits (rural << urban areas)
*Financial conflicts of interest
,*Biomed model --> patients/docs are uneducated
*malprac system
*underfunded public programs
*Slow diffusion of new evidence into patient care
Medical/Structural Issues (w quality) (4- FMND) - correct answer ✔✔1) FINANCIAL CONFLICTS
OF INTEREST
--Study found that 40% of practicing providers owned the services to which they referred
patients
--Physicians who benefit from referral to these labs/diagnostics referred 4x more than
physicians who didn't profit
2) MEDICAL ERRORS
--IOM: 44-98k deaths/year due to medical errors (3rd leading cause of death)
--Journals aren't trustworthy --> 52 cancer studies --> couldn't reproduce 47 of them
3) NOSOCOMIAL INFECTIONS (HAIs)
--Affects 5-10% of hospitlized patients ($20 billion HC costs)
4) DRUG COSTS AND ADRS
--Cost continues to increase, no price caps
--Drugs only have to be better than placebo
, --Trials -- frequently tested in young people, too brief to show side effects, hide negative results;
also run by drug companies; OVERDOSED AM: IN 2000: 2/3 of clinical trials were done by for-
profit research companies funded via drug industries
Cultural/Implicit Bias Issues in HC System (3) (wrt quality) (DID) - correct answer ✔✔1)
DISPROPORTIONATE ACCESS OF CARE
-- People from poor/underserved areas/POC/Homeless = higher morbidity/mortality, less
access, lower quality of care, incorrect/overtx
--STUDY: 228 million wrong predictions/med errors harm 1.3 mil ppl --> 100k die/year
2) IMPLICIT BIAS (combined w burnout = bad)
--Attitudes that lead doctors/researchers to unconsciously treat ppl differently based on race,
gender, etc
--Blacks are 2x less likely to receive pain meds for same injury than whites
3) DISCRIMINATION
--Black patients are systematically undertx
--EG: "race-based" estimates of GFR (indicates kidney function)-- under the assumption that Af-
Am have more muscle mass
Good quality consists of (CH. 10) - correct answer ✔✔-access, clear evidence-based guidelines,
correct evals (no over/underuse), organized system, well staffed specialists
IMPROVING QUaLITY (CH.10) (FMPPCCT (7)) - correct answer ✔✔-FINANCIAL SEP DECISIONS
FOR CLINICAL DECISION MAKING
-MEASURING PRAC PATTERNS (via outcomes + ind cases)
-PUBLIC REPORTING OF QUALITY
-P4P
-CLINICAL PRAC GUIDELINES (via Agency for HC Research and Quality)
